Many kids fall through gaps in dental care

May 17, 2014
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Paxton Metz wears protective sunglasses to get his teeth cleaned and sealed on Oct. 8, 2012, at the Southern Illinois University School of Dental Medicine clinic in Alton, Ill., as part of "Give Kids A Smile Day." / John Badman, The Telegraph via AP

by Marissa Evans, Kaiser Health News

by Marissa Evans, Kaiser Health News

No one wants to go to the dentist, but kids need to. A small cavity left to fester can grow into a big health problem. Although the government made pediatric dental care one of the health law's "essential benefits," new data suggest a lot of parents didn't buy dental coverage during the online enrollment period.

About 60% of U.S. children will have had cavities by age 5, according to a report from the American Academy of Pediatric Dentistry. Children with tooth decay are more likely to have ear and sinus infections. The chance of developing other chronic problems, such as obesity, diabetes and even heart disease, also increases.

Paul Reggiardo, chairman of the American Academy of Pediatric Dentistry's Council on Dental Benefit Programs, says early dental problems can affect children's learning, how they interact with other kids and their ability to eat.

"It starts having an impact much more than cavities," he says.

Many children get coverage through their parents' employer-based health insurance or the government-funded Children's Health Insurance Program and Medicaid, which serve low-income people. But the American Dental Association says there's still a big gap: 10 million children ages 2 through 18 had no dental insurance in 2011.

The health law marketplaces that opened last year were designed to help people who don't qualify for Medicaid and don't have workplace coverage. Parents seeking pediatric dental insurance had two options: purchasing it as part of a family medical plan or as a separate, stand-alone policy.

Federal officials don't yet know how many kids got dental coverage through a family medical plan in the first enrollment period, which formally ended March 31. But they have reported numbers for stand-alone dental plans sold through the federal website serving 36 states: Just 63,448 children received this coverage. Experts estimate the number of children who could potentially be eligible for coverage through the various health plans is between 6 million and 8 million. The number is difficult to pin down because kids' dental insurance is not part of the insurance mandate.

One reason is that shopping for coverage is complicated and confusing, experts say. Perhaps more important, there's no separate subsidy for buying dental coverage and no federal penalty for failing to buy it. Only three states - Kentucky, Nevada and Washington - require parents to buy a children's dental plan.

In light of these problems, "Are we expanding dental access for kids?" asks Marko Vujicic, chief economist and vice president of the American Dental Association's Health Policy Institute.

Only 34% of medical plans sold on the federal exchange included pediatric dental benefits, according to an ADA study. Parents often confronted difficult choices - the ideal medical plan for their family might not have dental care for the kids, for example. To get that coverage, they'd have to buy a stand-alone plan at an additional cost.

Stand-alone plans are sold as either high-option policies, which likely involve higher premiums but smaller out-of-pocket costs; or low-option plans, for which premium payments may be less expensive but enrollees may have more out-of-pocket costs.

Prices for stand-alone plans vary not only by option but also where people live. Insurance markets are regional, not national, so costs and competition vary greatly. For the current year, a family in Cleveland County in southwestern North Carolina could pay as little as $33 a month for a low-option children's dental plan while another family in Beaver County in southwest Utah could pay as little as $8 for the same level plan, according to a KHN analysis of premium data for the federal marketplace.

Nationwide, the average price of a low-option plan was $21 a month and the average for the high-option plan was $27.

The federal health law provides income-based tax credits for buying medical plans, but not always for buying a separate dental plan. "(Parents) don't get the same support for picking a dental plan and paying for it as they do with medical plans," says Joe Touschner, a senior health policy analyst with the Center for Children and Families at Georgetown University.

Ultimately, though, those who bought a dental plan may be left wondering how it works and what it pays for.

"I'm not sure consumers know what they are getting," Vujicic says.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.